Nearly half of the 47 recommendations by the 30-person advisory panel aim to increase the number and role of primary care physicians, which are the family doctors, internists and others who provide general care and preventive medicine.
“We need to improve primary care; I think that's generally understood,” says Dr. Tom Roberts, president of the Western Montana Clinic in Missoula. “And yet, if you look at the special interests that determine what health care is in this country, they're really not organizing to try to improve primary care.”
Members of Baucus' Montana Healthcare Reform Advisory Council also are making suggestions that don't necessarily align with the senator's stated reform plans.
For example, Kalispell pharmacist Tobey Schule says the country should look at a “one-payer system” that covers all Americans with government-administered health insurance.
“I thought, if you dumped everyone into one (health insurance) pot, maybe everyone would end up with a better deal,” Schule says. “I think it's something that we certainly could look at.
“Health care should be a given for a country like ours. There should be no one who is excluded because of finances.”
Baucus, chairman of the Senate Finance Committee, unveiled his own health reform plan last month. It includes a mix of public and private health insurance initiatives, and he's said he won't consider a government one-payer system.
Panel members say they don't expect Baucus to run with everything they suggest.
Instead, they see the panel as a sincere effort by Baucus to get feedback from the health care trenches on what reforms are most needed.
“He told us to let go of any personal attachment and instead focus on what's in the best interest of the country,” says Scott Duke, chief executive officer of Glendive Medical Center and a panel member. “The best I can tell, he's very serious about (reform). It's about as passionate as I've ever seen him.”
Sara Kuban, Baucus' press secretary in Washington, D.C., says ideas from council members will be considered along with input from national experts, the Obama administration and Baucus' Senate colleagues.
“Constructive conversations are necessary and will continue as Max works together with Montanans and his colleagues to reform the health care system,” she says.
The council members, who include hospital executives, physicians, nurses, business owners, insurers and consumer advocates, have submitted a wide variety of proposals, such as:
Allow Medicare to negotiate directly with pharmaceutical companies on drug prices, to reduce costs.
Allow insurance products to be sold across state lines, to give customers in rural states like Montana more options in the market.
Revise Medicaid so it's easier to direct its funding to home health care for the elderly instead of institutional nursing home care.
Take steps to create a wider system of electronic health records.
Create more incentives for preventive health care and adjust health insurance prices according to a person's health habits. For example, those who smoke or are overweight should pay an insurance surcharge.
Design reforms with the goal and principle of covering all Americans, no matter what the program, so nobody is without some basic health coverage.
Yet the shortage of primary care physicians easily got the most attention from council members of all stripes.
Among other things, they suggested revamping the payment system to better compensate for primary care, provide incentives for medical students to go into primary care, ease paperwork requirements for primary care physicians and design insurance to discourage use of specialists or “over-utilized, higher-priced care.”
Schule, who owns Sykes Pharmacy in downtown Kalispell, says if government decided to expand health coverage to all right now, there wouldn't be enough primary care physicians to handle the workload.
Roberts, who's practiced primary care medicine for most of his career, says dramatic changes are needed to increase the emphasis on primary care, because America can't sustain a health care system that relies on paying for more and more expensive procedures.
Most health care spending is on people who have chronic diseases, such as diabetes, high blood pressure and heart problems, and their care is better managed by primary care doctors, he says.
“Primary care has to be the foundation of our health care system,” he says. “This is for the health care system; it's not just for the primary care physicians. It's not about them making more money. It's about us preserving our health care system.
“This (current) system ultimately will not survive. Whether we have the political will and the foresight to make the right changes now remains to be seen.”
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